Roots Pediatric Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ROOTS PEDIATRIC DENTISTRY, LLC

Practice address

185 S Beadle Rd BLDG 1
Lafayette, LA 70508-4287

Phone

(337) 234-2349

Fax

(337) 261-1785

NPI assigned

Dec 9, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marjorie Broussard

Title

Business Manager

Phone

(337) 234-2349

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• ADRIENNE A. REVIERE, DDS. LLC Former legal business name

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1467111203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 S BEADLE RD BLDG 1",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705084287",
            "telephone_number": "337-234-2349",
            "fax_number": "337-261-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 S BEADLE RD BLDG 1",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705084287",
            "telephone_number": "337-234-2349",
            "fax_number": "337-261-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS PEDIATRIC DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "MARJORIE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "337-234-2349"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2870858",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "6569",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1865699",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "7085",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "officemanager@rootspediatricdental.com",
            "affiliation": "N",
            "endpointDescription": "Office Manager email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "185 S Beadle Rd Bldg 1",
            "city": "Lafayette",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705084287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ADRIENNE A. REVIERE, DDS. LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Robert W Romero, MD
• Stephanie Romero
• Sydni Larriviere Romero, RN
• Ronald Armand Jenkins
• Ronald J Daigle, MD, Apmc
• Yessica Olga Roque, CERTIFIED SW
• Kimberly Matrice Rose
• Mecca M Rose
• Torian Rose
• Lashonda Rosette

• Dental Clinic/Center in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Dental Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.